US20110301650A1 - Adjsutable bone anchor asembly - Google Patents
Adjsutable bone anchor asembly Download PDFInfo
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- US20110301650A1 US20110301650A1 US13/211,993 US201113211993A US2011301650A1 US 20110301650 A1 US20110301650 A1 US 20110301650A1 US 201113211993 A US201113211993 A US 201113211993A US 2011301650 A1 US2011301650 A1 US 2011301650A1
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- Prior art keywords
- crown
- pair
- receiver
- substantially flat
- opposite
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
- A61B17/7037—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other wherein pivoting is blocked when the rod is clamped
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/037—Automatic limiting or abutting means, e.g. for safety with a frangible part, e.g. by reduced diameter
Definitions
- the present disclosure relates to devices and methods useful in surgery, such as orthopedic surgery.
- it relates to anchors and other implants for use in tissue, to be placed during orthopedic surgery.
- an elongated member such as a bendable rod is disposed longitudinally along vertebrae or one or more vertebral segments.
- the rod may be bent to correspond to or approximate the normal curvature of the spine in the particular region being instrumented.
- the rod can be bent or otherwise formed into at least an approximation of a normal kyphotic curvature for the thoracic region of the spine, or a lordotic curvature for the lumbar region.
- an elongated member can be engaged to vertebrae along a length of the spinal column by way of a number of fixation elements.
- fixation elements can be provided which are configured to engage bones or bony tissue, such as specific portions of a vertebra or other bones.
- one such fixation element is a hook that is configured to engage a lamina of a vertebra.
- Another fixation element is a screw that can be threaded into various parts of the vertebra or other bones.
- Such procedures may be used to correct or treat a variety of deformities, injuries or other problems in bony structures such as vertebrae or other tissue.
- one or more rods are situated to one or both sides of the spine or spinous processes. Bone screws are threaded into several vertebral bodies, e.g. into the vertebral pedicles. The rods are affixed to the bone screws to apply corrective and/or stabilizing forces to the spine.
- FIG. 1 is a side elevational view of an embodiment of an adjustable bone anchor assembly.
- FIG. 2 is an exploded view of the embodiment depicted in FIG. 1 .
- FIG. 3A is a side elevational view of an embodiment of a receiver member shown in FIG. 2 .
- FIG. 3B is a front elevational view of the embodiment of a receiver member shown in FIG. 3A .
- FIG. 3C is a sectional view, taken along the lines 3 C- 3 C in FIG. 3A , and viewed in the direction of the arrows, of the embodiment of a receiver member shown in FIG. 3A .
- FIG. 3D is a sectional view, taken along the lines 3 D- 3 D of FIG. 3B and viewed in the direction of the arrows, of the embodiment of a receiver member shown in FIG. 3B .
- FIG. 3E is a sectional view, taken along the lines 3 E- 3 E of FIG. 3C and viewed in the direction of the arrows, of the embodiment of a receiver member shown in FIG. 3C .
- FIG. 4A is a side elevational view of an embodiment of a bone anchor in the embodiment shown in FIG. 2 .
- FIG. 4B is a sectional view, taken along the lines 4 B- 4 B of FIG. 4A and viewed in the direction of the arrows, of an embodiment of a bone anchor shown in FIG. 4A .
- FIG. 4C is a magnified view of an embodiment of a head of a bone anchor shown in FIG. 4A .
- FIG. 5A is a top view of an embodiment of a crown member used in the embodiment shown in FIG. 2 .
- FIG. 5B is a sectional view, taken along the lines 5 B- 5 B in FIG. 5A and viewed in the direction of the arrows, of an embodiment of a crown member shown in FIG. 5A .
- FIG. 5C is a side elevational view of the embodiment shown in FIG. 5A .
- FIG. 6A is a top view of an embodiment of a retaining member used in the embodiment shown in FIG. 2 .
- FIG. 6B is a sectional view, taken along the lines of 6 B- 6 B in FIG. 6A and viewed in the direction of the arrows, of an embodiment of a retaining member shown in FIG. 6A .
- FIG. 7 is an enlarged sectional view of an embodiment as in FIG. 1 .
- FIG. 8 is an exploded perspective view of an embodiment as in FIG. 7 .
- FIG. 9 is a side elevational view of an embodiment of an adjustable bone anchor assembly.
- FIG. 10 is an exploded view of the embodiment depicted in FIG. 9 .
- FIG. 11 is a side elevational view of an embodiment of a receiver member depicted in FIG. 9 .
- FIG. 12 is a sectional view, taken along the lines of 12 - 12 in FIG. 11 and viewed in the direction of the arrows, of the embodiment of a receiver member shown in FIG. 11 .
- FIG. 13 is a front elevational view of the embodiment of a receiver member depicted in FIG. 9 .
- FIG. 14 is an elevational view of an embodiment of an adjustable bone anchor assembly.
- FIG. 15 is an exploded view of the embodiment shown in FIG. 14 .
- FIG. 16 is an elevational view of the embodiment shown in FIG. 14 , rotated 90 degrees from the position in FIG. 14 .
- assembly 10 includes a receiver member 12 , a bone anchor 14 , a crown member 16 , and a retaining member 18 .
- Assembly 10 is connectable with an elongated member 20 ( FIG. 7 ) such as a spinal rod, pin,, bar or other implant construct, as further described below.
- Receiver member 12 has an axial opening 22 therethrough, which in the illustrated embodiment includes an upper opening portion 24 and a lower opening portion 26 .
- Opening 22 has a longitudinal axis, which in one embodiment is also a longitudinal axis of receiver member 12 .
- Part of opening 22 is a chamber 28 .
- chamber 28 has substantially cylindrically-shaped walls or surfaces 32 a and 32 b and generally flat walls or surfaces 34 a and 34 b , which may be parallel to each other and to the longitudinal axis of receiver member 12 .
- Walls 34 a , 34 b may have respective substantially cylindrical wall portions 36 a , 36 b.
- Opening portion 22 is partially surrounded by a chamfered or rounded edge 42 at a top portion 43 of receiver member 12 , and is surrounded by chamfered or rounded edge 44 at a bottom portion 45 of receiver member 12 .
- a groove 46 and associated ledge 48 around lower opening 24 may be provided in or adjacent bottom portion 45 of receiver member 12 .
- groove 46 is substantially elliptical or otherwise oval and extends around the entire perimeter of opening 22 , although it will be seen that groove 46 could extend only partially around the perimeter of opening 22 .
- Groove 46 has a depth A ( FIG. 7 ), and a major diameter B ( FIG. 3C ).
- the major diameter of groove 46 is generally parallel to the planes of surfaces 34 a , 34 b of receiver member 12 .
- Upper and lower opening portions 24 , 26 can have a variety of alternative or additional configurations, such as each having one or more sections of differing diameter(s).
- Receiver member 12 in the illustrated embodiment includes a pair of upright branches 50 , 52 between which opening 22 extends. Branches 50 , 52 further define a substantially U-shaped channel 54 transverse to opening 22 that communicates with opening 22 , and that is sized to accommodate elongated member 20 ( FIG. 7 ).
- internal threads 56 may be provided, which end well above the floor of channel 54 . If a cylindrical rod 20 of diameter equal to the width of channel 54 is placed in channel 54 as deep as possible, i.e. contacting the floor of channel 54 , the upper limit of rod 20 will be below threads 56 .
- a groove 57 which may be slightly larger than the major diameter of threads 56 , separates threads 56 from that upper limit of rod 20 .
- Branches 50 , 52 may also be provided with indentations or holes 58 , which allow the surgeon to grip receiver member 12 with an appropriate forceps, wrench or other gripping or turning tool (not shown).
- Internal thread 56 in a specific embodiment is a reverse angle thread, i.e. a thread in which a load flank faces down and at lease slightly away from opening 22 , as disclosed in commonly-owned U.S. Pat. No. 6,296,642, the disclosure of which is hereby incorporated by reference in its entirety.
- Top portion 43 of receiver member 12 (which includes some or all of branches 50 , 52 ) is narrower along channel 54 than bottom portion 45 of receiver member 12 in the illustrated embodiment, which reduces the bulk and profile of receiver member 12 .
- FIGS. 4A-4C an embodiment of a bone anchor 14 is shown.
- the illustrated embodiment of bone anchor 14 is a bone screw, which in one embodiment is substantially like the bone screw disclosed in U.S. Pat. No. 5,885,286, the disclosure of which is hereby incorporated by reference in its entirety.
- Anchor 14 includes an anchorage portion 64 to and a head portion 66 joined by a neck or shank portion 67 .
- anchorage portion 64 includes at least one thread 68 , which may be a cancellous self-tapping thread.
- Head portion 66 forms part of a sphere in the illustrated embodiment, though alternative curvate and other configurations may be employed At least one, and in the illustrated embodiment two, flat surfaces 70 may be provided on opposite sides of head 66 .
- Head 66 in one particular embodiment, includes a series of ridges 72 for improving purchase with the inside of crown member 16 .
- Head 66 may have alternative or additional friction-increasing surface configuration(s) such as roughening, shot peening or knurling.
- head 66 can include a tool-engaging print 74 , with which a tool (not shown) may be engaged to drive anchorage portion 64 into a bone.
- Tool-engaging print 74 is an interior print in the illustrated embodiment, although an exterior print could be used, and it may have any of a number of configurations, such as hexagonal, hexalobate, or other torque-transferring configurations.
- Other embodiments of anchor 14 are contemplated.
- anchor 14 could be a bone-engaging hook rather than a screw.
- anchorage portion 64 would be configured with a hook for engaging tissue, such as a bone portion, rather than a threaded elongated portion.
- head 66 has a width between surfaces 70 that is at least slightly smaller than the distance between surfaces 34 a , 34 b in receiver member 12 .
- the diameter of substantially spherical portions of head 66 is at least slightly smaller than the distance between surfaces 32 a , 32 b in receiver member 12 .
- Embodiments of head 66 of anchor 14 may be sized to fit in at least lower opening 26 and chamber 28 of receiver member 12 . As more fully described below, anchor 14 is inserted into receiver member 12 , in one embodiment by inserting head 66 through lower opening portion 26 and into chamber 28 through bottom end 45 of receiver member 12 .
- crown member 16 is a somewhat oblong disc, having an upper surface 78 with a beveled edge 80 and a lower surface 82 .
- Crown member 16 has a longitudinal central axis L extending thru a bore 84 .
- Bore 84 is sized and configured so that head 66 , and specifically tool-engaging print 74 , of anchor 14 may be accessed therethrough.
- Flat side surfaces 86 , 88 are provided on opposite sides of crown member 16 .
- Each flat surface 86 , 88 has a small rounded protrusion or tab 90 , 92 , in the illustrated embodiment, extending outwardly from flat surfaces 86 , 88 in a direction transverse to longitudinal axis L.
- Surfaces 93 , 94 between surfaces 86 , 88 are substantially circular in one embodiment.
- Lower surface 82 is configured to accommodate head 66 of anchor 14 , and in the illustrated embodiment lower surface 82 has the shape of part of a sphere. In other embodiments, lower surface 82 of crown member 16 can have one or more other shapes.
- Lower surface 82 can be provided with a friction- or purchase-enhancing surface configuration (e.g. roughening or knurling) for cooperation with head 66 of bone anchor 14 .
- Crown member 16 is sized and shaped to fit in chamber 28 of receiver member 12 .
- the outer dimension of crown member 16 is at least slightly smaller than the inner dimension of chamber 28 so that crown member 16 is slidably movable within chamber 28 in a longitudinal direction.
- crown member 16 is sized and configured so that sides 86 , 88 are adjacent walls 34 a , 34 b , walls 93 , 94 are adjacent walls 32 a , 32 b , and projections 90 , 92 fit at least partially in curved wall sections 36 a , 36 b of receiver member 12 .
- Crown member 16 and/or lower opening 26 of receiver member 12 may be sized so that crown member 16 may be inserted through lower opening 26 and into chamber 28 .
- the outer dimension of crown member 16 is larger than the inner dimension of upper opening 24 , so that crown member 16 cannot move into the upper opening portion 24 of the receiver member 12 .
- the illustrated embodiment of crown member 16 cannot move fully into channel 54 because of interference between sides 86 , 88 and an upper limit of walls 34 a , 34 b , and/or because of interference between projections 90 , 92 and an upper limit of walls 36 a , 36 b.
- retaining member 18 is substantially C-shaped spring or clip having arms 95 , 96 separated by a gap 97 .
- Retaining member 18 includes a top surface 98 and a bottom surface 100 .
- retaining member 18 has a substantially elliptical or otherwise oval outer shape, and also includes internal surfaces 102 , 104 , 106 that substantially surround a substantially circular aperture 108 .
- there may be single or multiple internal surfaces surrounding aperture 108 which surface(s) may be cylindrical, conical, spherical or of other appropriate configuration, or other inner and/or outer shapes of retaining member 18 .
- internal surface 102 forms a portion of a sphere having a radius substantially equal to the radius of head 66 of bone anchor 14
- internal surface 104 is substantially cylindrical
- internal surface 106 is substantially conical and angled outward to allow a greater range of angular positioning of anchor 14 .
- Retaining member 18 has an unloaded or natural outer width (e.g. minor width W 1 in the elliptic embodiment), i.e.
- retaining member 18 a width measured when retaining member 18 is under no contractive (gap-closing) or expansive (gap-opening) stress.
- arms 95 , 96 of retaining member 18 have a body width W 2 which in the illustrated embodiment is greater than depth A of groove 46 .
- the illustrated embodiment of retaining member 18 is further provided with a rotational or hinge area 120 , which may be somewhat narrower than W 2 or other parts of retaining member 18 .
- the width of retaining member 18 in one embodiment, is less than that of groove 46 , e.g. major and minor widths of an elliptic retaining member 18 are less than major and minor diameters of an elliptic groove 46 .
- the diameter of aperture 108 when retaining member 18 is in its unloaded state is smaller than the diameter of head 66 of bone anchor 14 .
- Retaining member 18 may be flat, somewhat wavy or undulating, or otherwise substantially planar in certain embodiments.
- assembly 10 is assembled in one embodiment substantially as follows. Bone anchor 14 , crown member 16 and retaining member 18 are inserted into receiver member 12 through bottom opening 26 , either individually or substantially in one step. As one example, crown member 16 may be inserted first, followed by bone anchor 14 with retaining member 18 being inserted last.
- crown member 16 may be oriented with respect to receiver member 12 and inserted so that its sides 86 , 88 are adjacent walls 34 a , 34 b , walls 93 , 94 are adjacent walls 32 a , 32 b , and projections 90 , 92 fit at least partially in curved wall sections 36 a , 36 b , and so that its underside 82 generally faces lower opening 26 of receiver member 12 .
- Crown member 16 may be slidable along the longitudinal axis of receiver member 12 prior to locking.
- Head 66 of anchor member 14 may be inserted through lower opening 26 to a position adjacent crown member 16 so that a portion of anchor 14 extends through lower opening 26 .
- a portion of head 66 may be in chamber 28 .
- Retaining member 18 is placed at least partially in groove 46 so that a portion of anchor 14 goes through aperture 108 of retaining member 18 .
- Retaining member 18 may be fitted around anchor 14 just below head 66 prior to, during or after insertion of anchor 14 into receiver member 12 .
- retaining member 18 can be placed around anchor 14 by inserting its anchorage portion 64 through aperture 108 and moving retaining member 18 over anchorage portion 64 toward head 66 .
- gap 97 of retaining member 18 may be pressed against shank or neck 67 of anchor 14 below head 66 , so that gap 97 expands and shank 67 moves through gap 97 and into aperture 108 , whereupon retaining member 18 may return to its original size and shape.
- Such expansion of retaining member 18 may be essentially symmetric around hinge portion 120 .
- retaining member 18 In inserting retaining member 18 , it may be forced upward into lower opening portion 26 .
- the surgeon may contract retaining member, making gap 96 smaller, with his or her fingers or other tools, or by forcing retaining member 18 against surfaces 44 and/or 48 of receiving member 12 , until the outer width of retaining member 18 allows its entry into receiver member 12 through lower opening 26 .
- Retaining member 18 is further advanced along opening 22 and into groove 46 so that retaining member 18 extends into at least a portion of groove 46 .
- retaining member 18 is elliptically shaped, and groove 46 is elliptically shaped, rotation of retaining member 18 about the longitudinal axis of receiver member 12 is limited or prevented by interference of part(s) of retaining member 18 with wall(s) of groove 46 .
- Notched area 120 of retaining member 18 allows for easy deflection of the arms 95 , 96 of retaining member 18 by reducing the force necessary to deflect such arms to close gap 97 .
- diameter B of groove 46 is smaller than the outer width W 1 of arms 95 , 96 of retaining member 18 in its natural or unloaded condition.
- diameter B of groove 46 may be the same size or slightly larger than the natural outer width WI of retaining member 18 .
- the lower surface 100 of retaining member 18 rests upon ledge 48 of groove 46 , and thereby holds retaining member 18 within groove 46 .
- Retaining member 18 may be expandable so that arms 95 , 96 contact the sides of groove 46 when assembly 10 is assembled and/or locked.
- Depth A of groove 46 is less than width W 2 of retaining member 18 , in certain embodiments, so that when retaining member 18 is in groove 46 , a portion of retaining member 18 projects into opening 22 .
- anchor 14 and crown member 16 are retained within opening 24 of receiver member 12 .
- Crown member 16 is supported by head 66 of anchor 14
- head 66 is supported by retaining member 18 (e.g. by internal surface 102 , if present).
- Retaining member 18 is held by groove 46 and/or ledge 48 of receiver member 12 .
- anchor 14 and crown member 16 do not pass through retaining ring 18 and out of receiver member 12 when retaining ring 18 is within groove 46 .
- Crown member 16 and head 66 of anchor 14 remain positioned in opening 22 and/or chamber 28 of receiving member 12 , and are slidable substantially along the longitudinal axis of receiver member 12 prior to locking.
- Anchor 14 is pivotable in one plane with respect to crown member 16 and receiving member 12 prior to locking, but in the illustrated embodiment is substantially limited from pivoting or rotating around the longitudinal axis of receiver member 12 because of the relationship between surfaces 70 of anchor 14 and corresponding surfaces of crown member 16 and/or receiver member 12 .
- assembly 10 can be used in a variety of surgical procedures, such as those for the correction of deformity (such as a scoliotic curvature, where one or both of translation and rotation of vertebrae or other movement in one or both of coronal and sagittal planes may be required), degeneration or trauma suffered by the spine or other tissues.
- deformity such as a scoliotic curvature, where one or both of translation and rotation of vertebrae or other movement in one or both of coronal and sagittal planes may be required
- degeneration or trauma suffered by the spine or other tissues such as those for the correction of deformity (such as a scoliotic curvature, where one or both of translation and rotation of vertebrae or other movement in one or both of coronal and sagittal planes may be required), degeneration or trauma suffered by the spine or other tissues.
- Assembly 10 may be assembled prior to use in a surgical procedure, although such assembling could be done by the surgeon, an assistant or another at any time.
- Anchor 14 is provided at a surgical site and connected to a vertebra (not shown). In the embodiment in which anchor 14 is a screw, it is threaded into the vertebra, for example into a prepared (e.g. drilled and tapped) hole. In other embodiments, for example where anchor 14 is a bone hook, threading into a bone and/or drilling a hole in the bone may not be necessary.
- Anchoring portion 64 is connected to the vertebra, and an appropriate turning tool, e.g. one usable with tool-engaging print 74 of anchor 14 through hole 84 in crown member 16 , may be used to thread anchor 14 into the bone.
- receiver member 12 When anchor 14 has been inserted or otherwise placed with respect to a vertebra to the desired depth, receiver member 12 can be positioned so that opening 22 forms a desired angle with anchor 14 .
- the angle 0 between anchor 14 and opening 22 can be any value up to 30 degrees in either direction. It will be seen that the maximum angle of anchor 14 relative to opening 22 can be changed in several ways, for example by thinning the shank or other portion of anchor 14 beneath head 66 , by providing a steeper angle of surface 44 relative to the longitudinal axis of receiver member 12 , and/or by placing groove 46 as close as possible to bottom end 24 of receiver member 12 .
- the surgeon may line up channel 54 and an elongated member 20 so that they are parallel, and/or may bend the elongated member to enable it to be easily reduced into receiver member 12 and provide the desired support to the vertebra(e).
- Assembly 10 allows for movement of receiver member 12 with respect to anchor 14 substantially in one plane, for example the sagittal plane, when or before elongated member 20 and channel 54 are aligned.
- surfaces 34 a , 34 b inside chamber 28 , outer sides 86 , 88 of to crown member 16 , and surfaces 70 on head 66 of anchor 14 will substantially limit or prevent anchor 14 from rotating with respect to receiver member 12 other than substantially in the plane including the longitudinal axis of anchor 14 and parallel to surfaces 70 of anchor 14 .
- receiver member 12 may be angled with respect to anchor 14 .
- Elongated member 20 which may be a cylindrical, flattened or otherwise shaped orthopedic rod, pin, bar, connector, or other implant, is coupled with assembly 10 .
- Elongated member 20 is placed in channel 54 of receiver member 12 , and adjacent top surface 78 of crown member 16 .
- a compression member 110 is connected to receiver member 12 , as by threading compression member 110 into threads 56 , and engaged with elongated member 20 .
- Compression member 110 in one embodiment, is a set screw or plug having external threads 112 and a print 114 for applying torque, and in a specific embodiment may be a break-off set screw, such as those disclosed in U.S. Pat. No.
- thread 112 is a reverse angle thread as disclosed in U.S. Pat. No. 6,296,642 to Morrison et al., incorporated herein by reference in its entirety, which is compatible with a reverse angle embodiment of thread 56 of receiver member 12 , described above.
- compression member 110 could be an internally-threaded nut.
- elongated member 20 is forced downward against crown member 16 , which pushes crown member 16 against head 66 of anchor 14 .
- Head 66 is thereby clamped between retaining member 18 and crown member 16 .
- ridges 72 are pressed into lower surface 82 of crown member 16 .
- Head 66 is pressed against retaining member 18 in groove 46 . In this way, anchor 14 is locked with respect to elongated member 20 and the remainder of assembly 10 in the desired angular position.
- crown member 16 may be made of a material somewhat softer than the material used for ridges 72 of head 66 of anchor 14 . Such construction will allow ridges 72 to penetrate somewhat more easily into interior surface 82 of crown member 16 during locking of assembly 10 , thereby providing a more definite purchase between ridges 72 and crown member 16 .
- crown member 16 may be made of a material somewhat softer than the material used for elongated member 20 . Such construction will allow upper surface 78 of crown member 16 to deform to a shape similar to or approximating that of elongated member 20 during locking of assembly 10 .
- elongated member 20 may be somewhat softer than crown member 16 so that upper surface 78 of crown member 16 bites into, penetrates, or otherwise deforms elongated member 20 .
- receiver member 212 is similar or identical in many respects to the embodiment of receiver member 12 .
- Features of receiver member 212 that are similar or identical to those of receiver member 12 have the same number with a 200 prefix.
- Receiver member 212 has a lower portion 212 a and an upper portion 212 b separated by a thinned section 212 c , in this illustrated embodiment.
- Lower portion 212 a is substantially the same as receiver member 12 , having an opening 222 therethrough with a longitudinal axis, which in one embodiment is also a longitudinal axis of receiver member 212 .
- Part of opening 222 is a chamber 228 , which in the illustrated embodiment has substantially cylindrically-shaped walls or surfaces (such as surface 232 a and an opposing surface) and generally flat walls or surfaces 234 a and 234 b , which may be parallel to each other and to the longitudinal axis of receiver member 212 .
- Walls 234 a , 234 b may have respective substantially cylindrical wall portions 236 a , 236 b .
- a chamfered or rounded edge 242 may be provided at or near the top of lower portion 212 a and/or the top of upper portion 212 b
- a chamfered or rounded edge 244 may be provided at a bottom portion 245 of lower portion 212 a .
- a groove 246 and associated ledge 248 may also be provided. Groove 246 is configured substantially like groove 46 , with shape(s) and dimension(s) as described and suggested above.
- Receiver member 212 in the illustrated embodiment includes a pair of upright branches 250 , 252 between which opening 222 extends. Branches 250 , 252 further define a substantially U-shaped channel 254 transverse to opening 222 that communicates with opening 222 , and that is sized to accommodate an elongated member. A portion of each branch 250 , 252 forms at least a part of lower portion 212 a of receiver member 212 , and a portion of each branch 250 , 252 forms at least a part of upper portion 212 b of receiver member 212 .
- internal threads 256 are formed in branches 250 , 252 through substantially the entire length of upper portion 212 b and into lower portion 212 a .
- Threads 256 end well above the floor of channel 254 . If a cylindrical rod 220 of diameter equal to the width of channel 254 is placed in channel 254 as deep as possible, i.e. contacting the floor of channel 254 , the upper limit of rod 220 will be below threads 256 . A groove 257 , which may be slightly larger than the major diameter of threads 256 , separates threads 256 from that upper limit of rod 220 . Branches 250 , 252 may also be provided with indentations or holes 258 , which allow the surgeon to grip receiver member 212 (or either or both of portions 212 a , 212 b ) with an appropriate forceps, wrench or other gripping or turning tool (not shown).
- Threads 256 in a specific embodiment can be a reverse angle thread, i.e. a thread in which a load flank faces down and at lease slightly away from opening 222 , as disclosed in commonly-owned U.S. Pat. No. 6,296,642, the disclosure of which is hereby incorporated by reference in its entirety.
- Upper portion 212 b of receiver member 212 includes portions of branches 250 , 252 having internal threads 256 and indentations 258 as discussed above, in the illustrated embodiment. Threads 256 may configured so that they are essentially continuous from upper portion 212 b to lower portion 212 a , with the possible exception of the portion at or around section 212 c .
- a compression member e.g. compression member 110 described above
- a set screw threaded into upper portion 212 b can be threaded along opening 222 into lower portion 212 a .
- upper portion 212 b is integrally formed with lower portion 212 a , although in other embodiments portions 212 a and 212 b can be separately made and joined together, or otherwise formed. Further, the illustrated embodiment shows upper portion 212 b to be of a height approximately the same as or slightly less than that of lower portion 212 a .
- Other embodiments of receiver member 212 could include an upper portion 212 b having a height that is half or less than that of lower portion 212 a , or could include an upper portion 212 b having a height that is substantially larger than that of lower portion 212 a.
- Thinned section 212 c separates upper portion 212 b and lower portion 212 a in the illustrated embodiment.
- This embodiment of section 212 c includes an external indentation or groove 260 , which may include scoring lines or other fracture-inducing or fracture-enabling features.
- An interior indentation 261 is also provided in the illustrated embodiment, which may interrupt threads 256 (if present) and may be somewhat deeper than the major diameter of threads 256 .
- Section 212 c has a thickness which is at least slightly less than the overall thickness of branches 250 , 252 , and in a particular embodiment that thickness is at least slightly less than the thickness of branches 250 , 252 measured from a thread trough in a branch to the exterior of that branch.
- Receiver member 212 can be assembled substantially as described above with embodiments of an anchor member 14 , a crown member 16 , and a retaining member 18 , such as those similar or identical to the embodiments described above, to make a bone anchor assembly. Further, the assembly made with receiver member 212 can be used in surgery substantially as described above. When the surgeon wishes to insert an elongated member 220 into receiver member 212 , he or she need not bend it or use a special reducing tool to insert it into the lower end of a receiving channel. Rather, he or she places a portion of elongated member 220 into channel 254 in upper portion 212 b of receiver member 212 . A set screw or other compression member (e.g.
- compression member 110 described above
- the compression member is a set screw
- the set screw is threaded into threads 256 , forcing elongated member 220 further down in channel 254 .
- elongated member 220 is forced all the way through upper portion 212 b , into lower portion 212 a , and against a crown member and/or anchor member in chamber 228 , substantially as described above with respect to assembly 10 .
- upper portion 212 b may be cut or sheared off or otherwise removed from lower portion 212 a .
- tool(s) for gripping or turning could be connected to one or both of upper portion 212 b and lower portion 212 a , and torque could be applied to shear or twist the portions apart.
- a tool with relatively sharp jaws could be applied to exterior groove 260 to cut off upper portion 212 b .
- Other methods for to physically separating upper portion 212 a from lower portion 212 b may be used. Once separated, upper portion 212 b may be removed from the surgical site and discarded.
- certain embodiments provide a bone anchor having a head portion and an anchoring portion that can pivot with respect to each other in substantially one plane, e.g. a sagittal plane, a transverse plane, a plane substantially between a sagittal and a transverse plane, or another plane.
- a sagittal plane e.g. a sagittal plane, a transverse plane, a plane substantially between a sagittal and a transverse plane, or another plane.
- Such embodiments may be essentially locked against pivoting with respect to each other in other planes by virtue of internal configurations.
- assembly 10 can be introduced to a surgical site as described herein or otherwise as the surgeon may desire, and inserted into vertebral tissue.
- the surgeon may prefer to install assembly 10 so that the plane in which receiver member 12 , 212 and anchor 14 can pivot with respect to each other is substantially sagittal, substantially vertical, and/or substantially parallel to at least part of the spinal column. It will be understood, of course, that the surgeon may orient assembly 10 as he or she wishes, for example so that the plane in which receiver member 12 , 212 and anchor 14 can pivot with respect to each other is non-sagitally oriented.
- assembly 10 Once assembly 10 is inserted into a vertebra, it can be threaded into a position that is one-quarter turn (90 degrees) short of its final position with respect to the vertebra.
- assembly 10 can be threaded into a vertebra so that it is one-quarter turn dorsal of that final position (e.g. substantially in a lateral plane). In such a pre-final position, movement in the sagittal plane of receiver member 12 , 212 with respect to anchor 14 is substantially limited or prevented.
- Correction techniques useful in addressing trauma and/or degenerative conditions can be applied to bones or to assembly 10 (or multiple assemblies 10 , if they are used) in such pre-final positions in vertebrae.
- the surgeon may press assemblies 10 together with his or her fingers or with a tool (not shown).
- the surgeon may pull or push apart assemblies 10 with his or her fingers or with a tool (not shown). In either case, force applied to the sides of assemblies 10 will cause a change in relative position between assemblies 10 , and will not substantially pivot receiver members 12 , 212 of assemblies 10 with respect to their respective anchors 14 .
- An interbody device may be implanted between the adjusted vertebrae so as to maintain the desired spacing between the vertebrae.
- Such operations on vertebrae, on one or more assemblies 10 , or other orthopedic elements may be made as the surgeon desires and/or as dictated by a particular patient's condition.
- assembly(s) 10 can be driven the final one-quarter turn into their respective vertebrae. Assembly(s) 10 then rest in the final position with respect to the vertebrae desired by the surgeon.
- An elongated member such as a spinal rod, bar or other item, may be inserted into channel 54 , 254 of receiver member 12 , 212 of each assembly 10 and locked, substantially as described above.
- the surgeon has in one device an essentially rigid screw in the direction of distraction and compression when needed, and in its final position a pivotable, angularly adjustable screw when a rod or other elongated member is being seated in it. It will be seen that embodiments of the methods described herein using two or more bone anchor assemblies can, as examples, use assembly 10 for each such bone anchor assembly, or can use other types of anchors along with one or more assembly 10 .
- the illustrated embodiment of assembly 10 shows an arrangement of surfaces 34 a , 34 b of receiver member 12 that will permit pivoting of anchor member 14 in a plane containing an axis through channel 54 . That is, the illustrated embodiment of assembly 10 shows substantially cylindrically-shaped surfaces 32 a and 32 b below channel 54 and generally flat surfaces 34 a and 34 b below branches 50 , 52 . Surfaces 34 a , 34 b could be positioned elsewhere in receiver member 12 so that a plane in which anchor member 14 pivots is oblique or perpendicular to channel 54 and to an elongated member 20 in it. An embodiment is shown in FIGS. 14-16 in which anchor member 14 pivots substantially perpendicularly to channel 54 ′ in receiver member 12 ′, i.e.
- receiver member 12 ′ in a transverse plane, making an angle ⁇ with respect to a longitudinal axis of receiver member 12 ′.
- internal geometry of receiver member 12 ′ is rotated about 90 degrees from that of receiver members 12 , 212 shown in FIGS. 1-3E and 8 - 13 , e.g., substantially cylindrically-shaped surfaces are below channel 54 ′ and generally flat surfaces are below branches 50 ′, 52 ′.
- this embodiment of an assembly 10 ′ is similar or to identical to assembly 10 and parts previously shown and described.
- the major diameter of the groove could be repositioned so as to be substantially parallel to the planes of one or more generally flat surfaces in receiver member 12 ′, which may be comparable to surfaces 34 a , 34 b of receiver member 12 .
- Assembly 10 ′ is used and assembled substantially as described above with respect to assembly 10 .
- Assembly 10 ′ can provide for certain orthopedic correction techniques, such as those described above with respect to inserting assembly 10 to a “pre-final” position.
- movement in a plane substantially along a rod (e.g. the sagittal plane) of receiver member 12 ′ with respect to anchor 14 is substantially limited or prevented.
- Correction techniques useful in addressing trauma and/or degenerative conditions such as compression, distraction, rotation and/or other adjustments of vertebrae or vertebral segments, can be applied to assembly 10 ′ (or multiple assemblies 10 ′, if they are used) or to bones.
- assemblies 10 ′ may press assemblies 10 ′ together with his or her fingers or with a tool (not shown).
- the surgeon may pull or push apart assemblies 10 ′ with his or her fingers or with a tool (not shown). In either case, force applied to the sides of assemblies 10 ′ will cause a change in relative position between assemblies 10 ′, and will not substantially pivot receiver members 12 ′ of assemblies 10 ′ with respect to their respective anchors 14 .
- An interbody device may be implanted between the adjusted vertebrae so as to maintain the desired spacing between the vertebrae.
- such operations on vertebrae, on one or more assemblies 10 ′, or other orthopedic elements may be made as the surgeon desires and/or as dictated by a particular patient's condition.
- embodiments of assembly 10 could be made without crown member 16 .
- surfaces 70 of head 66 of anchor 14 will be adjacent surfaces 34 a , 34 b of receiver member 12 , and the relationship between surfaces 70 and 34 a , 34 b will limit pivoting of anchor 14 with respect to receiver member 12 to substantially one plane.
- elongated member 20 would bear directly against head 66 in such embodiments.
- receiver members that are generally pivotable with respect to tissue or an anchor in such tissue in substantially one plane. That plane may be determined by the configuration of the assembly and/or by its positioning relative to tissue (e.g. a vertebra or other bone tissue).
- tissue e.g. a vertebra or other bone tissue.
- Surfaces within a receiver member of the assembly, surfaces on a crown member, and/or other features can be oriented so that an anchor and receiver member can pivot with respect to each other in a plane substantially parallel to the receiver member's channel, substantially perpendicular to the channel, or at any angle to the channel.
- the assembly can be connected to tissue so that the receiver member pivots substantially in one of an infinite number of planes, for example by rotating a screw-type anchor of an assembly into bone to a degree that produces pivoting substantially in a desired plane.
- a plane may be substantially sagittal, substantially transverse, or may be between sagittal and transverse, or any other plane desired by the surgeon and permitted by the anatomy to be instrumented.
- An assembly in which the receiver member is pivotable with respect to an anchor, or tissue to which the anchor is connected, in a plane between a sagittal and a transverse plane can be useful in implant constructs in the lower vertebrae, sacral and/or iliac area, among other surgical situations or procedures.
Abstract
A medical implant device has in one embodiment a receiver member for receiving an elongated member, a crown member, an anchor member and a retaining member. An embodiment of the receiver member has an axial opening, a transverse channel, a chamber including at least one substantially flat wall, and a groove. An embodiment of the crown member has at least one substantially flat side. An embodiment of the anchor member has a head with at least one substantially flat surface that may be parallel to the anchor member's longitudinal axis, and an anchoring portion. An embodiment of the retaining member is a substantially flat clip. The crown member and anchor member are inserted into the chamber, and the retaining member is inserted into the groove beneath them. The anchor member may be pivoted substantially in one plane with respect to the receiver member until locked.
Description
- The present disclosure relates to devices and methods useful in surgery, such as orthopedic surgery. In particular, it relates to anchors and other implants for use in tissue, to be placed during orthopedic surgery.
- In the field of orthopedic surgery, techniques and systems have been developed for correcting and stabilizing damage or malformation of bones, such as the vertebrae of the spine. In one type of system, an elongated member such as a bendable rod is disposed longitudinally along vertebrae or one or more vertebral segments. The rod may be bent to correspond to or approximate the normal curvature of the spine in the particular region being instrumented. For example, the rod can be bent or otherwise formed into at least an approximation of a normal kyphotic curvature for the thoracic region of the spine, or a lordotic curvature for the lumbar region.
- In such systems, an elongated member can be engaged to vertebrae along a length of the spinal column by way of a number of fixation elements. A variety of fixation elements can be provided which are configured to engage bones or bony tissue, such as specific portions of a vertebra or other bones. For instance, one such fixation element is a hook that is configured to engage a lamina of a vertebra. Another fixation element is a screw that can be threaded into various parts of the vertebra or other bones.
- Such procedures may be used to correct or treat a variety of deformities, injuries or other problems in bony structures such as vertebrae or other tissue. In one example of a spinal procedure utilizing a bendable rod, one or more rods are situated to one or both sides of the spine or spinous processes. Bone screws are threaded into several vertebral bodies, e.g. into the vertebral pedicles. The rods are affixed to the bone screws to apply corrective and/or stabilizing forces to the spine.
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FIG. 1 is a side elevational view of an embodiment of an adjustable bone anchor assembly. -
FIG. 2 is an exploded view of the embodiment depicted inFIG. 1 . -
FIG. 3A is a side elevational view of an embodiment of a receiver member shown inFIG. 2 . -
FIG. 3B is a front elevational view of the embodiment of a receiver member shown inFIG. 3A . -
FIG. 3C is a sectional view, taken along thelines 3C-3C inFIG. 3A , and viewed in the direction of the arrows, of the embodiment of a receiver member shown inFIG. 3A . -
FIG. 3D is a sectional view, taken along thelines 3D-3D ofFIG. 3B and viewed in the direction of the arrows, of the embodiment of a receiver member shown inFIG. 3B . -
FIG. 3E is a sectional view, taken along thelines 3E-3E ofFIG. 3C and viewed in the direction of the arrows, of the embodiment of a receiver member shown inFIG. 3C . -
FIG. 4A is a side elevational view of an embodiment of a bone anchor in the embodiment shown inFIG. 2 . -
FIG. 4B is a sectional view, taken along thelines 4B-4B ofFIG. 4A and viewed in the direction of the arrows, of an embodiment of a bone anchor shown inFIG. 4A . -
FIG. 4C is a magnified view of an embodiment of a head of a bone anchor shown inFIG. 4A . -
FIG. 5A is a top view of an embodiment of a crown member used in the embodiment shown inFIG. 2 . -
FIG. 5B is a sectional view, taken along the lines 5B-5B inFIG. 5A and viewed in the direction of the arrows, of an embodiment of a crown member shown inFIG. 5A . -
FIG. 5C is a side elevational view of the embodiment shown inFIG. 5A . -
FIG. 6A is a top view of an embodiment of a retaining member used in the embodiment shown inFIG. 2 . -
FIG. 6B is a sectional view, taken along the lines of 6B-6B inFIG. 6A and viewed in the direction of the arrows, of an embodiment of a retaining member shown inFIG. 6A . -
FIG. 7 is an enlarged sectional view of an embodiment as inFIG. 1 . -
FIG. 8 is an exploded perspective view of an embodiment as inFIG. 7 . -
FIG. 9 is a side elevational view of an embodiment of an adjustable bone anchor assembly. -
FIG. 10 is an exploded view of the embodiment depicted inFIG. 9 . -
FIG. 11 is a side elevational view of an embodiment of a receiver member depicted inFIG. 9 . -
FIG. 12 is a sectional view, taken along the lines of 12-12 inFIG. 11 and viewed in the direction of the arrows, of the embodiment of a receiver member shown inFIG. 11 . -
FIG. 13 is a front elevational view of the embodiment of a receiver member depicted inFIG. 9 . -
FIG. 14 is an elevational view of an embodiment of an adjustable bone anchor assembly. -
FIG. 15 is an exploded view of the embodiment shown inFIG. 14 . -
FIG. 16 is an elevational view of the embodiment shown inFIG. 14 , rotated 90 degrees from the position inFIG. 14 . - For the purposes of promoting an understanding of the principles of the disclosure, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the claims is thereby intended, such alterations and further modifications in the illustrated embodiments, and such further applications of the principles of the disclosure as illustrated therein, being contemplated as would normally occur to one skilled in the art to which the subject matter relates.
- Referring generally to
FIGS. 1 and 2 , there is shown an embodiment of abone anchor assembly 10. In that embodiment,assembly 10 includes areceiver member 12, abone anchor 14, acrown member 16, and a retainingmember 18.Assembly 10 is connectable with an elongated member 20 (FIG. 7 ) such as a spinal rod, pin,, bar or other implant construct, as further described below. - Referring now additionally to
FIGS. 3A-3E , 7 and 8, an embodiment of thereceiver member 12 is shown.Receiver member 12 has anaxial opening 22 therethrough, which in the illustrated embodiment includes anupper opening portion 24 and alower opening portion 26.Opening 22 has a longitudinal axis, which in one embodiment is also a longitudinal axis ofreceiver member 12. Part of opening 22 is achamber 28. In the illustrated embodiment,chamber 28 has substantially cylindrically-shaped walls or surfaces 32 a and 32 b and generally flat walls or surfaces 34 a and 34 b, which may be parallel to each other and to the longitudinal axis ofreceiver member 12.Walls 34 a, 34 b may have respective substantiallycylindrical wall portions - Opening
portion 22 is partially surrounded by a chamfered orrounded edge 42 at atop portion 43 ofreceiver member 12, and is surrounded by chamfered orrounded edge 44 at abottom portion 45 ofreceiver member 12. In oradjacent bottom portion 45 ofreceiver member 12, agroove 46 and associatedledge 48 aroundlower opening 24 may be provided. In the illustrated embodiment,groove 46 is substantially elliptical or otherwise oval and extends around the entire perimeter of opening 22, although it will be seen thatgroove 46 could extend only partially around the perimeter ofopening 22.Groove 46 has a depth A (FIG. 7 ), and a major diameter B (FIG. 3C ). In the illustrated embodiment, the major diameter ofgroove 46 is generally parallel to the planes ofsurfaces 34 a, 34 b ofreceiver member 12. Upper andlower opening portions -
Receiver member 12 in the illustrated embodiment includes a pair ofupright branches Branches U-shaped channel 54 transverse to opening 22 that communicates with opening 22, and that is sized to accommodate elongated member 20 (FIG. 7 ). In a specific embodiment,internal threads 56 may be provided, which end well above the floor ofchannel 54. If acylindrical rod 20 of diameter equal to the width ofchannel 54 is placed inchannel 54 as deep as possible, i.e. contacting the floor ofchannel 54, the upper limit ofrod 20 will be belowthreads 56. Agroove 57, which may be slightly larger than the major diameter ofthreads 56, separatesthreads 56 from that upper limit ofrod 20.Branches receiver member 12 with an appropriate forceps, wrench or other gripping or turning tool (not shown).Internal thread 56 in a specific embodiment is a reverse angle thread, i.e. a thread in which a load flank faces down and at lease slightly away from opening 22, as disclosed in commonly-owned U.S. Pat. No. 6,296,642, the disclosure of which is hereby incorporated by reference in its entirety.Top portion 43 of receiver member 12 (which includes some or all ofbranches 50, 52) is narrower alongchannel 54 thanbottom portion 45 ofreceiver member 12 in the illustrated embodiment, which reduces the bulk and profile ofreceiver member 12. - Referring now generally to
FIGS. 4A-4C , an embodiment of abone anchor 14 is shown. The illustrated embodiment ofbone anchor 14 is a bone screw, which in one embodiment is substantially like the bone screw disclosed in U.S. Pat. No. 5,885,286, the disclosure of which is hereby incorporated by reference in its entirety.Anchor 14 includes ananchorage portion 64 to and ahead portion 66 joined by a neck orshank portion 67. In the embodiment in which anchor 14 is a screw,anchorage portion 64 includes at least onethread 68, which may be a cancellous self-tapping thread.Head portion 66 forms part of a sphere in the illustrated embodiment, though alternative curvate and other configurations may be employed At least one, and in the illustrated embodiment two,flat surfaces 70 may be provided on opposite sides ofhead 66.Head 66, in one particular embodiment, includes a series ofridges 72 for improving purchase with the inside ofcrown member 16.Head 66 may have alternative or additional friction-increasing surface configuration(s) such as roughening, shot peening or knurling. Further,head 66 can include a tool-engagingprint 74, with which a tool (not shown) may be engaged to driveanchorage portion 64 into a bone. Tool-engagingprint 74 is an interior print in the illustrated embodiment, although an exterior print could be used, and it may have any of a number of configurations, such as hexagonal, hexalobate, or other torque-transferring configurations. Other embodiments ofanchor 14 are contemplated. For example,anchor 14 could be a bone-engaging hook rather than a screw. In that embodiment,anchorage portion 64 would be configured with a hook for engaging tissue, such as a bone portion, rather than a threaded elongated portion. - In one specific example,
head 66 has a width betweensurfaces 70 that is at least slightly smaller than the distance betweensurfaces 34 a, 34 b inreceiver member 12. The diameter of substantially spherical portions ofhead 66 is at least slightly smaller than the distance betweensurfaces receiver member 12. Embodiments ofhead 66 ofanchor 14 may be sized to fit in at leastlower opening 26 andchamber 28 ofreceiver member 12. As more fully described below,anchor 14 is inserted intoreceiver member 12, in one embodiment by insertinghead 66 throughlower opening portion 26 and intochamber 28 throughbottom end 45 ofreceiver member 12. - Referring now to
FIGS. 5A-5C , there is shown an embodiment ofcrown member 16. In that embodiment,crown member 16 is a somewhat oblong disc, having anupper surface 78 with abeveled edge 80 and alower surface 82.Crown member 16 has a longitudinal central axis L extending thru abore 84.Bore 84 is sized and configured so thathead 66, and specifically tool-engagingprint 74, ofanchor 14 may be accessed therethrough. Flat side surfaces 86, 88 are provided on opposite sides ofcrown member 16. Eachflat surface tab flat surfaces surfaces Lower surface 82 is configured to accommodatehead 66 ofanchor 14, and in the illustrated embodimentlower surface 82 has the shape of part of a sphere. In other embodiments,lower surface 82 ofcrown member 16 can have one or more other shapes.Lower surface 82 can be provided with a friction- or purchase-enhancing surface configuration (e.g. roughening or knurling) for cooperation withhead 66 ofbone anchor 14. -
Crown member 16 is sized and shaped to fit inchamber 28 ofreceiver member 12. The outer dimension ofcrown member 16 is at least slightly smaller than the inner dimension ofchamber 28 so thatcrown member 16 is slidably movable withinchamber 28 in a longitudinal direction. In a particular embodiment,crown member 16 is sized and configured so thatsides adjacent walls 34 a, 34 b,walls adjacent walls projections curved wall sections receiver member 12.Crown member 16 and/orlower opening 26 ofreceiver member 12 may be sized so thatcrown member 16 may be inserted throughlower opening 26 and intochamber 28. Further, in the illustrated embodiment the outer dimension ofcrown member 16 is larger than the inner dimension ofupper opening 24, so thatcrown member 16 cannot move into theupper opening portion 24 of thereceiver member 12. The illustrated embodiment ofcrown member 16 cannot move fully intochannel 54 because of interference betweensides walls 34 a, 34 b, and/or because of interference betweenprojections walls - Referring now to
FIGS. 6A-6B , there is shown an embodiment of retaining member orsnap ring 18 of the present invention. In the illustrated embodiment, retainingmember 18 is substantially C-shaped spring orclip having arms gap 97. Retainingmember 18 includes atop surface 98 and abottom surface 100. In the illustrated embodiment, retainingmember 18 has a substantially elliptical or otherwise oval outer shape, and also includesinternal surfaces circular aperture 108. In other embodiments, there may be single or multiple internalsurfaces surrounding aperture 108, which surface(s) may be cylindrical, conical, spherical or of other appropriate configuration, or other inner and/or outer shapes of retainingmember 18. In certain embodiments,internal surface 102 forms a portion of a sphere having a radius substantially equal to the radius ofhead 66 ofbone anchor 14,internal surface 104 is substantially cylindrical, andinternal surface 106 is substantially conical and angled outward to allow a greater range of angular positioning ofanchor 14. Retainingmember 18 has an unloaded or natural outer width (e.g. minor width W1 in the elliptic embodiment), i.e. a width measured when retainingmember 18 is under no contractive (gap-closing) or expansive (gap-opening) stress. Further,arms member 18 have a body width W2 which in the illustrated embodiment is greater than depth A ofgroove 46. The illustrated embodiment of retainingmember 18 is further provided with a rotational or hingearea 120, which may be somewhat narrower than W2 or other parts of retainingmember 18. The width of retainingmember 18, in one embodiment, is less than that ofgroove 46, e.g. major and minor widths of anelliptic retaining member 18 are less than major and minor diameters of anelliptic groove 46. The diameter ofaperture 108 when retainingmember 18 is in its unloaded state is smaller than the diameter ofhead 66 ofbone anchor 14. Retainingmember 18 may be flat, somewhat wavy or undulating, or otherwise substantially planar in certain embodiments. - Generally referring to
FIGS. 1 , 2 and 7,assembly 10 is assembled in one embodiment substantially as follows.Bone anchor 14,crown member 16 and retainingmember 18 are inserted intoreceiver member 12 throughbottom opening 26, either individually or substantially in one step. As one example,crown member 16 may be inserted first, followed bybone anchor 14 with retainingmember 18 being inserted last. With the illustrated embodiments,crown member 16 may be oriented with respect toreceiver member 12 and inserted so that itssides adjacent walls 34 a, 34 b,walls adjacent walls projections curved wall sections underside 82 generally faceslower opening 26 ofreceiver member 12.Crown member 16 may be slidable along the longitudinal axis ofreceiver member 12 prior to locking.Head 66 ofanchor member 14 may be inserted throughlower opening 26 to a positionadjacent crown member 16 so that a portion ofanchor 14 extends throughlower opening 26. A portion ofhead 66 may be inchamber 28. Retainingmember 18 is placed at least partially ingroove 46 so that a portion ofanchor 14 goes throughaperture 108 of retainingmember 18. Retainingmember 18 may be fitted aroundanchor 14 just belowhead 66 prior to, during or after insertion ofanchor 14 intoreceiver member 12. In certain embodiments, retainingmember 18 can be placed aroundanchor 14 by inserting itsanchorage portion 64 throughaperture 108 and moving retainingmember 18 overanchorage portion 64 towardhead 66. In other embodiments,gap 97 of retainingmember 18 may be pressed against shank orneck 67 ofanchor 14 belowhead 66, so thatgap 97 expands andshank 67 moves throughgap 97 and intoaperture 108, whereupon retainingmember 18 may return to its original size and shape. Such expansion of retainingmember 18 may be essentially symmetric aroundhinge portion 120. By placingcrown member 16adjacent head 66 ofanchor 14, so thatlower surface 82 ofcrown member 16 adjoinshead 66, andfitting anchor 14 and retainingmember 18 together, substantially simultaneous insertion ofbone anchor 14,crown member 16 and retainingmember 18 intoreceiver member 12 can be accomplished. - In inserting retaining
member 18, it may be forced upward intolower opening portion 26. The surgeon may contract retaining member, makinggap 96 smaller, with his or her fingers or other tools, or by forcing retainingmember 18 againstsurfaces 44 and/or 48 of receivingmember 12, until the outer width of retainingmember 18 allows its entry intoreceiver member 12 throughlower opening 26. Retainingmember 18 is further advanced along opening 22 and intogroove 46 so that retainingmember 18 extends into at least a portion ofgroove 46. In embodiments in which retainingmember 18 is elliptically shaped, andgroove 46 is elliptically shaped, rotation of retainingmember 18 about the longitudinal axis ofreceiver member 12 is limited or prevented by interference of part(s) of retainingmember 18 with wall(s) ofgroove 46. Notchedarea 120 of retainingmember 18 allows for easy deflection of thearms member 18 by reducing the force necessary to deflect such arms to closegap 97. - As noted above, in one specific embodiment diameter B of
groove 46 is smaller than the outer width W1 ofarms member 18 in its natural or unloaded condition. Thus, when retainingmember 18 is ingroove 46, retainingmember 18 presses against the walls ofgroove 46. In other embodiments, diameter B ofgroove 46 may be the same size or slightly larger than the natural outer width WI of retainingmember 18. In this case, thelower surface 100 of retainingmember 18 rests uponledge 48 ofgroove 46, and thereby holds retainingmember 18 withingroove 46. Retainingmember 18 may be expandable so thatarms groove 46 whenassembly 10 is assembled and/or locked. Depth A ofgroove 46 is less than width W2 of retainingmember 18, in certain embodiments, so that when retainingmember 18 is ingroove 46, a portion of retainingmember 18 projects intoopening 22. - When retaining
ring 18 is ingroove 46,anchor 14 andcrown member 16 are retained within opening 24 ofreceiver member 12.Crown member 16 is supported byhead 66 ofanchor 14, andhead 66 is supported by retaining member 18 (e.g. byinternal surface 102, if present). Retainingmember 18 is held bygroove 46 and/orledge 48 ofreceiver member 12. Thus, in thisembodiment anchor 14 andcrown member 16 do not pass through retainingring 18 and out ofreceiver member 12 when retainingring 18 is withingroove 46.Crown member 16 andhead 66 ofanchor 14 remain positioned in opening 22 and/orchamber 28 of receivingmember 12, and are slidable substantially along the longitudinal axis ofreceiver member 12 prior to locking.Anchor 14 is pivotable in one plane with respect tocrown member 16 and receivingmember 12 prior to locking, but in the illustrated embodiment is substantially limited from pivoting or rotating around the longitudinal axis ofreceiver member 12 because of the relationship betweensurfaces 70 ofanchor 14 and corresponding surfaces ofcrown member 16 and/orreceiver member 12. - Use of the illustrated embodiment of
assembly 10 will be described with respect to spinal surgery, but it is understood thatassembly 10 could be used in connection with other surgical locations or tissues.Assembly 10 can be used in a variety of surgical procedures, such as those for the correction of deformity (such as a scoliotic curvature, where one or both of translation and rotation of vertebrae or other movement in one or both of coronal and sagittal planes may be required), degeneration or trauma suffered by the spine or other tissues. -
Assembly 10 may be assembled prior to use in a surgical procedure, although such assembling could be done by the surgeon, an assistant or another at any time.Anchor 14 is provided at a surgical site and connected to a vertebra (not shown). In the embodiment in which anchor 14 is a screw, it is threaded into the vertebra, for example into a prepared (e.g. drilled and tapped) hole. In other embodiments, for example whereanchor 14 is a bone hook, threading into a bone and/or drilling a hole in the bone may not be necessary. Anchoringportion 64 is connected to the vertebra, and an appropriate turning tool, e.g. one usable with tool-engagingprint 74 ofanchor 14 throughhole 84 incrown member 16, may be used tothread anchor 14 into the bone. Whenanchor 14 has been inserted or otherwise placed with respect to a vertebra to the desired depth,receiver member 12 can be positioned so that opening 22 forms a desired angle withanchor 14. In the illustrated embodiment, the angle 0 betweenanchor 14 andopening 22 can be any value up to 30 degrees in either direction. It will be seen that the maximum angle ofanchor 14 relative to opening 22 can be changed in several ways, for example by thinning the shank or other portion ofanchor 14 beneathhead 66, by providing a steeper angle ofsurface 44 relative to the longitudinal axis ofreceiver member 12, and/or by placinggroove 46 as close as possible tobottom end 24 ofreceiver member 12. The surgeon may line upchannel 54 and anelongated member 20 so that they are parallel, and/or may bend the elongated member to enable it to be easily reduced intoreceiver member 12 and provide the desired support to the vertebra(e).Assembly 10 allows for movement ofreceiver member 12 with respect to anchor 14 substantially in one plane, for example the sagittal plane, when or beforeelongated member 20 andchannel 54 are aligned. As noted, surfaces 34 a, 34 b insidechamber 28,outer sides crown member 16, and surfaces 70 onhead 66 ofanchor 14 will substantially limit or preventanchor 14 from rotating with respect toreceiver member 12 other than substantially in the plane including the longitudinal axis ofanchor 14 and parallel tosurfaces 70 ofanchor 14. - As noted above,
receiver member 12 may be angled with respect toanchor 14.Elongated member 20, which may be a cylindrical, flattened or otherwise shaped orthopedic rod, pin, bar, connector, or other implant, is coupled withassembly 10.Elongated member 20 is placed inchannel 54 ofreceiver member 12, and adjacenttop surface 78 ofcrown member 16. Acompression member 110 is connected toreceiver member 12, as by threadingcompression member 110 intothreads 56, and engaged withelongated member 20.Compression member 110, in one embodiment, is a set screw or plug havingexternal threads 112 and aprint 114 for applying torque, and in a specific embodiment may be a break-off set screw, such as those disclosed in U.S. Pat. No. 5,885,286 to Sherman et al. or U.S. Pat. No. 6,193,719 to Gournay et al., incorporated herein by reference in their entireties. In a further embodiment,thread 112 is a reverse angle thread as disclosed in U.S. Pat. No. 6,296,642 to Morrison et al., incorporated herein by reference in its entirety, which is compatible with a reverse angle embodiment ofthread 56 ofreceiver member 12, described above. In embodiments in whichreceiver member 12 is externally threaded,compression member 110 could be an internally-threaded nut. - As
compression member 110 is tightened, elongatedmember 20 is forced downward againstcrown member 16, which pushescrown member 16 againsthead 66 ofanchor 14.Head 66 is thereby clamped between retainingmember 18 andcrown member 16. In embodiments in which head 66 includesridges 72,ridges 72 are pressed intolower surface 82 ofcrown member 16.Head 66 is pressed against retainingmember 18 ingroove 46. In this way,anchor 14 is locked with respect toelongated member 20 and the remainder ofassembly 10 in the desired angular position. - Materials for the components as described above and in other embodiments include stainless steel, cobalt-chrome alloys, titanium or any other sturdy biocompatible material. In a particular embodiment,
crown member 16 may be made of a material somewhat softer than the material used forridges 72 ofhead 66 ofanchor 14. Such construction will allowridges 72 to penetrate somewhat more easily intointerior surface 82 ofcrown member 16 during locking ofassembly 10, thereby providing a more definite purchase betweenridges 72 andcrown member 16. In another specific embodiment,crown member 16 may be made of a material somewhat softer than the material used forelongated member 20. Such construction will allowupper surface 78 ofcrown member 16 to deform to a shape similar to or approximating that ofelongated member 20 during locking ofassembly 10. In other embodiments, elongatedmember 20 may be somewhat softer thancrown member 16 so thatupper surface 78 ofcrown member 16 bites into, penetrates, or otherwise deforms elongatedmember 20. - Referring now generally to
FIGS. 9-13 , there is shown another embodiment of areceiver member 212, which is similar or identical in many respects to the embodiment ofreceiver member 12. Features ofreceiver member 212 that are similar or identical to those ofreceiver member 12 have the same number with a 200 prefix. -
Receiver member 212 has alower portion 212 a and anupper portion 212 b separated by a thinnedsection 212 c, in this illustrated embodiment.Lower portion 212 a is substantially the same asreceiver member 12, having anopening 222 therethrough with a longitudinal axis, which in one embodiment is also a longitudinal axis ofreceiver member 212. Part ofopening 222 is achamber 228, which in the illustrated embodiment has substantially cylindrically-shaped walls or surfaces (such assurface 232 a and an opposing surface) and generally flat walls or surfaces 234 a and 234 b, which may be parallel to each other and to the longitudinal axis ofreceiver member 212.Walls cylindrical wall portions rounded edge 242 may be provided at or near the top oflower portion 212 a and/or the top ofupper portion 212 b, and a chamfered orrounded edge 244 may be provided at abottom portion 245 oflower portion 212 a. Agroove 246 and associatedledge 248 may also be provided.Groove 246 is configured substantially likegroove 46, with shape(s) and dimension(s) as described and suggested above. -
Receiver member 212 in the illustrated embodiment includes a pair ofupright branches Branches U-shaped channel 254 transverse to opening 222 that communicates withopening 222, and that is sized to accommodate an elongated member. A portion of eachbranch lower portion 212 a ofreceiver member 212, and a portion of eachbranch upper portion 212 b ofreceiver member 212. In a specific embodiment,internal threads 256 are formed inbranches upper portion 212 b and intolower portion 212 a.Threads 256, if provided, end well above the floor ofchannel 254. If acylindrical rod 220 of diameter equal to the width ofchannel 254 is placed inchannel 254 as deep as possible, i.e. contacting the floor ofchannel 254, the upper limit ofrod 220 will be belowthreads 256. Agroove 257, which may be slightly larger than the major diameter ofthreads 256, separatesthreads 256 from that upper limit ofrod 220.Branches portions Threads 256 in a specific embodiment can be a reverse angle thread, i.e. a thread in which a load flank faces down and at lease slightly away from opening 222, as disclosed in commonly-owned U.S. Pat. No. 6,296,642, the disclosure of which is hereby incorporated by reference in its entirety. -
Upper portion 212 b ofreceiver member 212 includes portions ofbranches internal threads 256 andindentations 258 as discussed above, in the illustrated embodiment.Threads 256 may configured so that they are essentially continuous fromupper portion 212 b tolower portion 212 a, with the possible exception of the portion at or aroundsection 212 c. In that embodiment, a compression member (e.g. compression member 110 described above) can be inserted intoupper portion 212 b and moved down tolower portion 212 a. For example, a set screw threaded intoupper portion 212 b can be threaded along opening 222 intolower portion 212 a. In the illustrated embodiment,upper portion 212 b is integrally formed withlower portion 212 a, although inother embodiments portions upper portion 212 b to be of a height approximately the same as or slightly less than that oflower portion 212 a. Other embodiments ofreceiver member 212 could include anupper portion 212 b having a height that is half or less than that oflower portion 212 a, or could include anupper portion 212 b having a height that is substantially larger than that oflower portion 212 a. - Thinned
section 212 c, as noted above, separatesupper portion 212 b andlower portion 212 a in the illustrated embodiment. This embodiment ofsection 212 c includes an external indentation or groove 260, which may include scoring lines or other fracture-inducing or fracture-enabling features. Aninterior indentation 261 is also provided in the illustrated embodiment, which may interrupt threads 256 (if present) and may be somewhat deeper than the major diameter ofthreads 256.Section 212 c has a thickness which is at least slightly less than the overall thickness ofbranches branches -
Receiver member 212 can be assembled substantially as described above with embodiments of ananchor member 14, acrown member 16, and a retainingmember 18, such as those similar or identical to the embodiments described above, to make a bone anchor assembly. Further, the assembly made withreceiver member 212 can be used in surgery substantially as described above. When the surgeon wishes to insert anelongated member 220 intoreceiver member 212, he or she need not bend it or use a special reducing tool to insert it into the lower end of a receiving channel. Rather, he or she places a portion ofelongated member 220 intochannel 254 inupper portion 212 b ofreceiver member 212. A set screw or other compression member (e.g. compression member 110 described above) is inserted intoopening 222 aboveelongated member 220. In the embodiment in which the compression member is a set screw, the set screw is threaded intothreads 256, forcingelongated member 220 further down inchannel 254. In this way,elongated member 220 is forced all the way throughupper portion 212 b, intolower portion 212 a, and against a crown member and/or anchor member inchamber 228, substantially as described above with respect toassembly 10. - Once the compression member is tightened against
elongated member 220 to lock the assembly to the surgeon's satisfaction,upper portion 212 b may be cut or sheared off or otherwise removed fromlower portion 212 a. As one example, tool(s) for gripping or turning could be connected to one or both ofupper portion 212 b andlower portion 212 a, and torque could be applied to shear or twist the portions apart. As another example, a tool with relatively sharp jaws could be applied toexterior groove 260 to cut offupper portion 212 b. Other methods for to physically separatingupper portion 212 a fromlower portion 212 b may be used. Once separated,upper portion 212 b may be removed from the surgical site and discarded. - As will be noted from the above description, certain embodiments provide a bone anchor having a head portion and an anchoring portion that can pivot with respect to each other in substantially one plane, e.g. a sagittal plane, a transverse plane, a plane substantially between a sagittal and a transverse plane, or another plane. Such embodiments may be essentially locked against pivoting with respect to each other in other planes by virtue of internal configurations.
- As previously noted, the embodiments described above (and others) can be used for a variety of surgical procedures. Another example of such a procedure concerns applications in which a spinal trauma or degenerative condition exists, and one or
more assemblies 10 are used in which thereceiver member anchor 14 can pivot with respect to each other in substantially one plane. In such cases,assembly 10 can be introduced to a surgical site as described herein or otherwise as the surgeon may desire, and inserted into vertebral tissue. In many surgical procedures, the surgeon may prefer to installassembly 10 so that the plane in whichreceiver member anchor 14 can pivot with respect to each other is substantially sagittal, substantially vertical, and/or substantially parallel to at least part of the spinal column. It will be understood, of course, that the surgeon may orientassembly 10 as he or she wishes, for example so that the plane in whichreceiver member anchor 14 can pivot with respect to each other is non-sagitally oriented. - Once
assembly 10 is inserted into a vertebra, it can be threaded into a position that is one-quarter turn (90 degrees) short of its final position with respect to the vertebra. For example, in a situation in which the final position ofassembly 10 with respect to a vertebra is to be such thatchannel receiver member assembly 10 can be threaded into a vertebra so that it is one-quarter turn dorsal of that final position (e.g. substantially in a lateral plane). In such a pre-final position, movement in the sagittal plane ofreceiver member multiple assemblies 10, if they are used) in such pre-final positions in vertebrae. For example, if compression is desired, the surgeon may pressassemblies 10 together with his or her fingers or with a tool (not shown). As another example, if distraction is desired, the surgeon may pull or push apartassemblies 10 with his or her fingers or with a tool (not shown). In either case, force applied to the sides ofassemblies 10 will cause a change in relative position betweenassemblies 10, and will not substantially pivotreceiver members assemblies 10 with respect to theirrespective anchors 14. An interbody device may be implanted between the adjusted vertebrae so as to maintain the desired spacing between the vertebrae. Such operations on vertebrae, on one ormore assemblies 10, or other orthopedic elements may be made as the surgeon desires and/or as dictated by a particular patient's condition. - Once any adjustment of vertebrae has been performed, and the spine or a portion of it is in a position desired by the surgeon, assembly(s) 10 can be driven the final one-quarter turn into their respective vertebrae. Assembly(s) 10 then rest in the final position with respect to the vertebrae desired by the surgeon. An elongated member, such as a spinal rod, bar or other item, may be inserted into
channel receiver member assembly 10 and locked, substantially as described above. Using embodiments of the above methods and assemblies, the surgeon has in one device an essentially rigid screw in the direction of distraction and compression when needed, and in its final position a pivotable, angularly adjustable screw when a rod or other elongated member is being seated in it. It will be seen that embodiments of the methods described herein using two or more bone anchor assemblies can, as examples,use assembly 10 for each such bone anchor assembly, or can use other types of anchors along with one ormore assembly 10. - While the embodiments have been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only certain embodiments have been shown and described and that all changes and modifications that come within the spirit of the disclosure are desired to be protected.
- For example, the illustrated embodiment of
assembly 10 shows an arrangement ofsurfaces 34 a, 34 b ofreceiver member 12 that will permit pivoting ofanchor member 14 in a plane containing an axis throughchannel 54. That is, the illustrated embodiment ofassembly 10 shows substantially cylindrically-shapedsurfaces channel 54 and generallyflat surfaces 34 a and 34 b belowbranches Surfaces 34 a, 34 b could be positioned elsewhere inreceiver member 12 so that a plane in which anchormember 14 pivots is oblique or perpendicular to channel 54 and to anelongated member 20 in it. An embodiment is shown inFIGS. 14-16 in which anchormember 14 pivots substantially perpendicularly to channel 54′ inreceiver member 12′, i.e. in a transverse plane, making an angle θ with respect to a longitudinal axis ofreceiver member 12′. In that embodiment, internal geometry ofreceiver member 12′ is rotated about 90 degrees from that ofreceiver members FIGS. 1-3E and 8-13, e.g., substantially cylindrically-shaped surfaces are belowchannel 54′ and generally flat surfaces are belowbranches 50′, 52′. In other respects, this embodiment of anassembly 10′ is similar or to identical toassembly 10 and parts previously shown and described. If an elliptical groove (similar to groove 46) and retaining member (similar to member 18) are used inassembly 10′, the major diameter of the groove could be repositioned so as to be substantially parallel to the planes of one or more generally flat surfaces inreceiver member 12′, which may be comparable tosurfaces 34 a, 34 b ofreceiver member 12. -
Assembly 10′ is used and assembled substantially as described above with respect toassembly 10.Assembly 10′ can provide for certain orthopedic correction techniques, such as those described above with respect to insertingassembly 10 to a “pre-final” position. Onceassembly 10′ is inserted into a vertebra as desired, movement in a plane substantially along a rod (e.g. the sagittal plane) ofreceiver member 12′ with respect to anchor 14 is substantially limited or prevented. Correction techniques useful in addressing trauma and/or degenerative conditions, such as compression, distraction, rotation and/or other adjustments of vertebrae or vertebral segments, can be applied toassembly 10′ (ormultiple assemblies 10′, if they are used) or to bones. For example, if compression is desired, the surgeon may pressassemblies 10′ together with his or her fingers or with a tool (not shown). As another example, if distraction is desired, the surgeon may pull or push apartassemblies 10′ with his or her fingers or with a tool (not shown). In either case, force applied to the sides ofassemblies 10′ will cause a change in relative position betweenassemblies 10′, and will not substantially pivotreceiver members 12′ ofassemblies 10′ with respect to theirrespective anchors 14. An interbody device may be implanted between the adjusted vertebrae so as to maintain the desired spacing between the vertebrae. As previously noted, such operations on vertebrae, on one ormore assemblies 10′, or other orthopedic elements may be made as the surgeon desires and/or as dictated by a particular patient's condition. - As another example, embodiments of
assembly 10 could be made withoutcrown member 16. In such embodiments, surfaces 70 ofhead 66 ofanchor 14 will beadjacent surfaces 34 a, 34 b ofreceiver member 12, and the relationship betweensurfaces anchor 14 with respect toreceiver member 12 to substantially one plane. Further,elongated member 20 would bear directly againsthead 66 in such embodiments. - As discussed above, several embodiments of the assembly have receiver members that are generally pivotable with respect to tissue or an anchor in such tissue in substantially one plane. That plane may be determined by the configuration of the assembly and/or by its positioning relative to tissue (e.g. a vertebra or other bone tissue). Surfaces within a receiver member of the assembly, surfaces on a crown member, and/or other features can be oriented so that an anchor and receiver member can pivot with respect to each other in a plane substantially parallel to the receiver member's channel, substantially perpendicular to the channel, or at any angle to the channel. The assembly can be connected to tissue so that the receiver member pivots substantially in one of an infinite number of planes, for example by rotating a screw-type anchor of an assembly into bone to a degree that produces pivoting substantially in a desired plane. With reference to a human body, such a plane may be substantially sagittal, substantially transverse, or may be between sagittal and transverse, or any other plane desired by the surgeon and permitted by the anatomy to be instrumented. An assembly in which the receiver member is pivotable with respect to an anchor, or tissue to which the anchor is connected, in a plane between a sagittal and a transverse plane can be useful in implant constructs in the lower vertebrae, sacral and/or iliac area, among other surgical situations or procedures.
Claims (26)
1.-45. (canceled)
46. An orthopedic medical apparatus comprising:
a receiver member defining a longitudinal opening having upper and lower portions extending along a longitudinal axis, said receiver member also defining a channel transversely intersecting said upper portion of said longitudinal opening and configured for receipt of an elongated member;
a crown member positioned within said lower portion of said longitudinal opening, said crown member having an interior region at least partially bound by an interior lower surface; and
a bone anchor member having a head portion and a bone engaging portion extending from said head portion, said head portion at least partially positioned within said interior region of said crown member and including an upper surface positioned proximately adjacent said interior lower surface of said crown member; and
wherein said receiver member, said crown member and said bone anchor member cooperate to substantially limit pivotal movement of said bone anchor member relative to said receiver member within a single plane.
47. The apparatus of claim 46 , wherein said lower portion of said longitudinal opening defined by said receiver member includes a pair of opposed substantially flat internal surfaces extending generally along said longitudinal axis; and
wherein said head portion of said bone anchor member includes a pair of opposite substantially flat external surfaces positioned adjacent and arranged substantially parallel with said pair of opposed substantially flat internal surfaces of said receiver member.
48. The apparatus of claim 47 , wherein said crown member includes first and second lateral openings arranged on opposite sides of said crown member and each extending laterally through external surfaces of said crown member and in communication with said interior region; and
wherein said pair of opposite substantially flat external surfaces of said bone anchor member are generally aligned with said first and second lateral openings in said crown member.
49. The apparatus of claim 47 , wherein said crown member includes a pair of opposite substantially flat external surfaces positioned adjacent and arranged substantially parallel with said pair of opposed substantially flat internal surfaces of said receiver member.
50. The apparatus of claim 49 , wherein said crown member includes a first lateral opening extending laterally through one of said opposite substantially flat external surfaces and in communication with said interior region, and a second lateral opening extending laterally through the other of said opposite substantially flat external surfaces and in communication with said interior region; and
wherein said pair of opposite substantially flat external surfaces of said bone anchor member are generally aligned with said first and second lateral openings in said crown member.
51. The apparatus of claim 46 , wherein said lower portion of said longitudinal opening defined by said receiver member includes a pair of opposed substantially flat internal surfaces extending generally along said longitudinal axis; and
wherein said crown member includes a pair of opposite substantially flat external surfaces positioned adjacent and arranged substantially parallel with said pair of opposed substantially flat internal surfaces of said receiver member.
52. The apparatus of claim 51 , wherein each of said pair of opposed substantially flat internal surfaces of said receiver member defines a recess extending generally along said longitudinal axis; and
wherein said crown member includes a projection extending from each of said pair of opposite substantially flat external surfaces, said projections defined by said crown member slidably positioned within said recesses defined by said receiver member.
53. The apparatus of claim 51 , wherein said head portion of said bone anchor member includes a pair of opposite substantially flat external surfaces positioned adjacent and arranged substantially parallel with said pair of opposite substantially flat external surfaces of said crown member.
54. The apparatus of claim 51 , wherein said crown member includes a pair of opposite substantially cylindrical external surfaces extending from one of said flat external surfaces to an opposite one of said flat external surfaces to provide said crown member with an oblong disc configuration.
55. The apparatus of claim 46 , wherein said crown member includes a pair of opposite substantially flat inner surfaces in said interior region; and
wherein said head portion of said bone anchor member includes a pair of opposite substantially flat external surfaces positioned adjacent and arranged substantially parallel with said pair of opposite substantially flat inner surfaces in said interior region of said crown member.
56. The apparatus of claim 55 , wherein said crown member is non-rotatably positioned within said lower portion of said longitudinal opening defined by said receiver member to substantially prevent rotational movement of said crown member about said longitudinal axis.
57. The apparatus of claim 56 , wherein said lower portion of said longitudinal opening defined by said receiver member includes a pair of opposed substantially flat internal surfaces extending generally along said longitudinal axis; and
wherein said crown member includes a pair of opposite substantially flat external surfaces positioned adjacent and arranged substantially parallel with said pair of opposed substantially flat internal surfaces of said receiver member to substantially prevent rotational movement of said crown member about said longitudinal axis.
58. The apparatus of claim 56 , wherein said lower portion of said longitudinal opening defined by said receiver member includes a pair of opposite recesses extending generally along said longitudinal axis; and
wherein said crown member includes a pair of opposite projections extending from an external surface thereof and slidably positioned within said recesses defined by said receiver member to substantially prevent rotational movement of said crown member about said longitudinal axis.
59. The apparatus of claim 46 , wherein said crown member is non-rotatably positioned within said lower portion of said longitudinal opening defined by said receiver member to substantially prevent rotational movement of said crown member about said longitudinal axis.
60. The apparatus of claim 59 , wherein said lower portion of said longitudinal opening defined by said receiver member includes a pair of opposite recesses extending generally along said longitudinal axis; and
wherein said crown member includes a pair of opposite projections extending from an external surface thereof and slidably positioned within said recesses defined by said receiver member to substantially prevent rotational movement of said crown member about said longitudinal axis.
61. The apparatus of claim 46 , wherein said lower interior surface of said crown member and said upper surface of said bone anchor member are each at least partially spherical shaped.
62. The apparatus of claim 46 , further comprising an elongated member at least partially position in said channel; and
wherein said elongated member does not contact said head portion of said anchor member.
63. The apparatus of claim 46 , wherein said channel of said receiver member extends along a transverse axis which runs substantially along the elongated member positioned in said channel, said transverse axis being substantially parallel to said single plane.
64. The apparatus of claim 46 , wherein said channel of said receiver member extends along a transverse axis which runs substantially along the elongated member positioned in said channel, said transverse axis being substantially perpendicular to said single plane.
65. The apparatus of claim 46 , wherein said receiver member includes a groove extending about said longitudinal axis and communicating with said longitudinal opening; and
further comprising a retaining member at least partially positioned within said groove and extending about at least a portion of said bone anchor member and positioned below said head portion to retain said head portion within said lower portion of said longitudinal opening defined by said receiver member.
66. The apparatus of claim 65 , wherein said retaining member is non-rotatably positioned in said groove whereby relative rotation of said retaining member in said groove is substantially limited.
67. The apparatus of claim 66 , wherein said groove and said retaining member are each substantially oval-shaped whereby relative rotation of said retaining member in said groove is substantially limited.
68. The apparatus of claim 66 , wherein said groove and said retaining member each have an elliptical shape whereby relative rotation of said retaining member in said groove is substantially limited.
69. The apparatus of claim 68 , wherein said elliptical shape of said groove and said retaining member has a major diameter that is generally parallel with said single plane.
70. The apparatus of claim 65 , wherein said retaining member is elliptical-shaped and has a major diameter that is generally parallel with said single plane.
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EP1945118A2 (en) | 2008-07-23 |
AU2006303883A1 (en) | 2007-04-26 |
WO2007047074A3 (en) | 2007-10-25 |
US9155566B2 (en) | 2015-10-13 |
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KR20080072848A (en) | 2008-08-07 |
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JP2009511227A (en) | 2009-03-19 |
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